[Congressional Record Volume 143, Number 152 (Tuesday, November 4, 1997)]
[Senate]
[Pages S11700-S11701]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           SURGE IN DIABETES

 Mr. DOMENICI. Mr. President, as I work with my colleagues to 
increase federal support for combating the incidence of diabetes 
particularly among minorities such as American Indians, Hispanics, 
Blacks, and Asians, I would like to draw your attention to an article 
in Monday's Washington Times, November 3, 1997. It is by Joyce Howard 
Price and entitled ``Surge in diabetes tied to unhealthy lifestyles.''
  Dr. Gerald Bernstein, President-elect of the American Diabetes 
Association, is reported to say that the national increase in diabetes 
was predictable, ``given that the population is older, fatter, and less 
active.''
  Dr. Bernstein was referring to a report from the Centers for Disease 
Control and Prevention (CDC) estimating that 16 million Americans 
currently have diabetes, but only 10 million have been diagnosed. He 
said, ``Cancer is much more dramatic and devastating. With diabetes, 
you erode and rot away. It's almost like leprosy.''
  The article goes on to quote Dr. Richard C. Eastman, director of the 
National Institute of Diabetes and Digestive and Kidney Diseases who 
said, ``While we usually get an increase of 3 to 4 percent, there was 
an 8 percent increase this year. We fund 1 in 4 or 1 in 5 
investigators.'' Dr. Eastman estimates the current national research 
effort in diabetes at $200 million.
  Health and Human Services (HHS) Secretary Donna Shalala agreed with 
me earlier this year that a special effort is needed to create a multi-
million dollar effort for a ``large-scale, coordinated primary, 
secondary, and tertiary prevention effort among the Navajo, who have a 
large population with a high incidence of diabetes and risk factors for 
diabetes.''
  I have reached agreements in the Senate Appropriations bill for 
Labor-HHS to fund such a center for preventing diabetes in Gallup, New 
Mexico. In a colloquy with Subcommittee Chairman Arlen Specter, we will 
affirm the need for this center in our national approach to alleviating 
the acute increases in diabetes, especially among American Indians 
whose incidence rate is almost three times the national average.
  Among Navajo Indians over age 45, two in five have been diagnosed as 
diabetic, and many experts believe that almost four in five actually 
have diabetes, but we will not know until our outreach and testing 
efforts are improved on this vast Indian reservation.
  Dr. Bernstein ``points out that the gene that predisposes someone to 
diabetes is five times more prevalent in American Indians than in 
whites and twice as prevalent in blacks, Hispanics and Asians than in 
non-Hispanic whites.'' He says the disease has ``failed to get priority 
status because it strikes minorities disproportionately.''
  He is absolutely right about the lack of attention to the problems of 
Navajo and Zuni Indians in New Mexico and Arizona. I would remind my 
colleagues that the Balanced Budget Act of 1998 has a $30 million per 
year program for preventing and treating diabetes among American 
Indians through the Indian Health Service (IHS). This commitment is for 
five years or a total of $150 million.
  I am currently working with HHS Secretary Shalala to coordinate the 
efforts of this IHS funding from the Balanced Budget Act with CDC to 
focus on designing more culturally relevant prevention and diagnosis 
approaches in a new prevention research center in Gallup, New Mexico. 
Even if we are slow to learn more about treating this dreaded disease, 
enough is known today to significantly control the negative end results 
of diabetes like blindness, amputation, and kidney failure.
  I hope my colleagues will continue to support my efforts to create 
this very specialized center for the study of improving prevention 
techniques for Indians and other minorities. In the case of Navajo and 
Zuni Indians, prevention can be difficult to incorporate into daily 
reservation life. Exercise programs may not be readily available, 
dietary changes may be contrary to local custom for preparing foods, or 
soft drinks may be routinely substituted for drinking water that is not 
plentiful or potable.
  These kinds of factors in Indian life will be studied carefully at 
the Gallup Diabetes Prevention Research Center. Recommendations and CDC 
assistance will be provided to IHS service providers throughout the 
Navajo Nation, the Zuni Pueblo, and other Apache and

[[Page S11701]]

Pueblo Indians in New Mexico and Arizona. It is my hope that improved 
diagnostic and prevention programs will readily flow from this Gallup 
center to all IHS facilities around the country.
  It may surprise my colleagues as it did me, that in the 1950's the 
IHS officially reported negligible rates of diabetes among Navajo 
Indians. In less than 50 years, diabetes has gone from negligible to 
rampant and epidemic.
  I commend the Washington Times for this timely and informative update 
on the surge in diabetes in our nation. I ask to have the entire 
article printed in the Record following my remarks.
  I believe this article is a poignant reminder of the seriousness of 
this disease and its rapid growth in our country. My colleagues can 
count on me to continue to help with the critical funding to control 
this disease with every sensible means possible, especially among the 
First Americans who seem to suffer at disproportionately high rates. 
With our funding successes of this year, I would urge my colleagues to 
continue to seek ways to combat the slow physical erosion that Dr. 
Bernstein described as being almost like leprosy.
  Dr. Bernstein is advocating for a billion dollars to expand urgent 
research and treatment of diabetes. I do not see this amount possible 
in our current budget situation, but I do concur that the medical costs 
of treating diabetes will continue to escalate unless our medical and 
prevention research efforts are more successful. I thank the Senate for 
this year's strong support of our efforts in this year's budget to 
improve the situation for all Americans who are susceptible to the 
ravages of diabetes.
  The article follows:

               [From the Washington Times, Nov. 3, 1997]

   Surge in Diabetes Tied to Unhealthy Lifestyles--Doctors Call for 
                         Federal Research Funds

                        (By Joyce Howard Price)

       The president-elect of the American diabetes Association, 
     Dr. Gerald Bernstein, says no one should be surprised by the 
     explosion of diabetes in the United States today, confirmed 
     in a new federal report.
       Given that the population is older, fatter and less active, 
     Dr. Bernstein says, the continued increase in diabetes was 
     predictable. He also criticizes the federal government for 
     ``totally inadequate'' levels of support for research.
       With all its complications, he says, diabetes costs the 
     nation about $140 billion a year--about 15 percent of all 
     U.S. health expenditures:
       ``While cancer, HIV [and other major diseases] get $5 to 
     $10 for research for every $100 spent on health care, 
     diabetes gets just 25 cents,'' says Dr. Bernstein, director 
     of the Harold Rifkin Diabetes Center in New York.
       A report by the federal Centers for Disease Control and 
     Prevention says about 16 million Americans currently have 
     diabetes, but only about 10 million have been diagnosed. The 
     number of diagnosed cases is up from 1.6 million in 1958.
       Diabetes is the nation's seventh leading killer and was the 
     primary cause of more than 59,200 deaths in 1995, according 
     to the National Center for Health Statistics. But data also 
     indicate it may have contributed to as many as 180,000 deaths 
     that year.
       ``We are becoming a more overweight population, we are less 
     active and we are also getting somewhat older,'' says Dr. 
     Frank Vinicor, director of the CDC's diabetes division. ``If 
     you put all of those factors together, we are seeing a 
     chronic disease epidemic occurring.''
       Diabetes is a disease caused by a deficiency of insulin, a 
     hormone secreted by the pancreas that is necessary for the 
     metabolism of sugar.
       Of the estimated 16 million diabetics in the United States 
     today, less than 1 million have Type I diabetes, meaning 
     their pancreases do not work at all, and they are insulin-
     dependent. Type I diabetes usually occurs in childhood or 
     adolescence.
       The overwhelming majority of diabetics have Type 2 
     diabetes, a form of the disease that usually occurs after age 
     40 and is usually treated by diet, pills or both.
       ``The prevalence of Type 2 diabetes is increasing 
     tremendously in the United States as people adapt more 
     sedentary lifestyles and obesity increases,'' says Dr. 
     Stephen Clement, director of the Diabetes Center at 
     Georgetown University Medical Center.
       Dr. Bernstein says ``more women die of diabetes than breast 
     cancer.''
       Nevertheless, he says, it has been hard to ``politicize'' 
     diabetes except when young children are involved, because the 
     average Type 2 diabetic is a ``fat [adult] individual who's 
     not compliant'' with recommendations that he or she exercise 
     and adopt a healthy diet.
       ``Cancer is much more dramatic and devastating. With 
     diabetes, you erode and rot away. It's almost like 
     leprosy,'' he says, explaining why this disease has been 
     given short shrift by political leaders, the media and 
     those handing out research dollars. He says the disease 
     has failed to get priority status because it strikes 
     minorities disproportionately.
       He points out that the gene that predisposes someone to 
     diabetes is five times more prevalent in American Indians 
     than in whites and twice as prevalent in blacks, Hispanics 
     and Asians than in non-Hispanic whites.
       Dr. Richard C. Eastman, director of the National Institute 
     of Diabetes and Digestive and Kidney Diseases, declines to 
     comment on the adequacy of research funding for diabetes, 
     which he says is currently $200 million a year.
       ``We had a record (funding) increase this year,'' he says. 
     ``While we usually get an increase of 3 to 4 percent, there 
     was an 8 percent increase this year. We fund 1 in 4 or 1 in 5 
     investigators.''
       Dr. Bernstein says the recent push for stepped-up diabetes 
     research money came from medical insurers, overwhelmed by 
     having to pay the staggering costs of treating patients 
     stricken with strokes, cardiovascular disorders, nerve 
     damage, kidney problems, limb amputations, and vision loss 
     triggered by diabetes.
       Cardiovascular disease and stroke risk are two to four 
     times more common among diabetics than the general 
     population, and better than 60 percent of diabetics have high 
     blood pressure and mild to severe neuropathy, or nerve 
     damage.
       ``This disease is going to break the economic back of this 
     country, so the amount provided [by the federal government] 
     for diabetes research should be a billion dollars a year,'' 
     Dr. Bernstein says.
       As evidence of the need for more research, he cites a 
     recent study by researchers at the University of Arkansas 
     ``who found a teen-age population that was obese, 
     hypertensive [had high blood pressure], and also had Type 2 
     diabetes,'' a condition usually confined to middle-aged 
     adults. ``So we're now seeing it's all over the place.''
       Dr. Clement agrees a lot more federal money is needed for 
     research. But he and Dr. Eastman point out that the National 
     Institutes of Health is currently funding large studies 
     designed to determine if both types of diabetes can be 
     prevented.

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